Jennie R. Joe

A lifestyle intervention improves plasma insulin levels among Native American high school youth.

BACKGROUND Worldwide, type 2 diabetes prevalence is increasing, with Native American populations particularly at risk. The Zuni Pueblo, with a history of wellness activities, volunteered to test the feasibility and efficacy of a high school-based diabetes prevention intervention. METHODS This school-based intervention used a multiple cross-sectional design to evaluate outcome measures at 0, 1.5, and 3 years against an Anglo comparison group. The Zuni high school diabetes prevention program included an educational component targeting decreased consumption of sugared beverages, knowledge of diabetes risk factors, and a youth-oriented fitness center. Main outcome measures were plasma glucose and insulin measured fasting and 30 min after a 75-g glucose challenge. RESULTS Plasma glucose levels were normal at baseline for Zuni (n = 72) and Anglo (n = 37) youth and did not significantly change throughout the study. At baseline, fasting and 30-min plasma insulin levels were significantly elevated for Zuni youth; they showed significant steady declines for both males and females throughout the study (P = 0.06 to P = 0.000 for trends using quantile regression). By Year 3, values for Zuni males (n = 29) equaled Anglo comparison values, while Zuni female (n = 26) values had declined but were still higher than Anglo comparison values. CONCLUSIONS Among at-risk youth, an environmentally based lifestyle intervention may significantly suppress markers of type 2 diabetes risk.

Implementing women's cancer screening programs in American Indian and Alaska Native populations.

The National Breast and Cervical Cancer Early Detection Program provides funding to tribes and tribal organizations to implement comprehensive cancer screening programs using a program model developed for state health departments. We conducted a multiple-site case study using a participatory research process to describe how 5 tribal programs implemented screening services, and to identify strategies used to address challenges in delivering services to American Indian and Alaska Native women. We analyzed data from semistructured interviews with 141 key informants, 16 focus groups with 132 program-eligible women, and program documents. Several challenges regarding the delivery of services were revealed, including implementing screening programs in busy acute-care environments, access to mammography, providing culturally sensitive care, and providing diagnostic/treatment services in rural and remote locations. Strategies perceived as successful in meeting program challenges included identifying a “champion” or main supporter of the program in each clinical setting, using mobile mammography, using female providers, and increasing the capacity to provide diagnostic services at screening sites. The results should be of interest to an international audience, including those who work with health-related programs targeting indigenous women or groups that are marginalized because of culture, geographic isolation, and/or socioeconomic position.

Some Thoughts About the Epidemiology of Alcohol and Drug Use Among American Indian/Alaska Native Populations

Researchers have established that rates of alcohol and illicit drug use among American Indians/Alaska Natives vary by tribe, gender, and age group, making it difficult to get an accurate estimate of the actual extent of the problem of substance abuse within this population group. Although percentage rates of alcohol consumption are higher in non-Hispanic Whites, American Indians/Alaska Natives nevertheless have the highest alcohol-related mortality rates and rates of substance use and dependence of all ethnic groups. Alcohol-related motor vehicle accidents are especially high for American Indian/Alaska Natives. Similarly, illicit drug use is higher among American Indians/Alaska Natives across all age groups compared to non-Indians. Data indicate that American Indians/Alaska Natives have the highest rates of use for marijuana, cocaine, inhalants, hallucinogens, and non-medical use of psychotherapeutics compared to other ethnic groups. Anecdotally, use of amphetamine appears to be high within some American Indian/Alaska Native tribes and has become a serious concern for most American Indian/Alaska Native communities. The percentage of American Indian/Alaska Native women using illicit drugs is lower than that found in men, except in younger age groups, in which percentage rates of illicit drug use by women in some tribes are comparable to rates for men.

Recommendations for advancing opportunities to increase physical activity in racial/ ethnic minority communities

We provide suggestions for advancing opportunities for effective and sustainable strategies for increasing physical activity in racial/ethnic minority populations.

Employment Barriers and Work Motivation for Navajo Rehabilitation Clients.

The Navajo nation provides vocational rehabilitation (VR) services to Navajo clients residing on and off the Navajo reservation. To evaluate motivation among disabled Navajo workers participating in VR programs, this study investigated the sociocultural meanings of work and its importance in the self-identity of contemporary Navajo workers and clients who apply for these services. Selected sociocultural variables that focused on cultural identity and perceptions as well as attitudes towards work were included as part of an assessment designed to predict motivation for employment success. The results of this study suggest that VR counsellors who work with Native American clients should recognize sociocultural history and the cultural perceptions of work as important factors in the rehabilitation and vocational planning process.

Government Policies and Disabled People in American Indian Communities

ABSTRACT Although services and resources for disabled people in the United States have improved greatly as a result of legislation and advocacy efforts, many of the disabled in American Indian communities have yet to benefit from these advances. Inaccessibility to services is often complicated by problems and debates over which agency, state or federal, is responsible or has jurisdiction to provide the services. Meanwhile, Indian communities struggle to accomplish what they can with limited resources.

Stuck inside the federal-indian funding relationship: A tale of two evaluations

Two case studies are presented to compare and contrast the challenges encountered when attempting to conduct participatory evaluations (P-Es) with tribal programs that represented two extremes of collaboration between the programs and evaluators. In one case, the P-E was successful because the principals were invested in the program, whereas in the second case, the absence of a shared program vision hampered the ability to adequately evaluate the program. The authors contend that governmental funding agencies have responsibilities to ensure that their expectations are appropriate, the proposed program is feasible, and that technical assistance should be provided before the grant is written, not after it has been funded.

Principles and strategies for improving the prevention of cardio-metabolic diseases in indigenous populations: An international Delphi study

The disparity in life expectancy between Indigenous and non-Indigenous populations, including within high-income countries, is driven by a heightened risk of cardio-metabolic diseases. The current study recruited independent panels of experts in Indigenous cardio-metabolic health from Australia, New Zealand and the United States, in order to establish local consensus opinion and initiate dialogue on appropriate prevention strategies. Therefore, a three-round Delphi process was used to consolidate and compare the opinions of 60 experts, 20 from each country. Round one, the experts were asked twelve open-ended questions across six domains: (i) prevention; (ii) consultation; (iii) educational resources; (iv) societal issues; (v) workforce issues; (vi) culture and family. Round two, the experts completed a structured questionnaire based on results from the first round, in which they ranked items according to their importance. Final round, the experts were asked to re-rank the same items after receiving summary feedback about the rank ordering from the previous round. Several themes emerged common to all three countries: (i) socio-economic and education inequalities should be addressed; (ii) educational, behaviour change and prevention strategies should address physical environmental determinants and be responsive to the local context, including being culturally appropriate; and (iii) cultural appropriateness can be achieved through consultation with Indigenous communities, cultural competency training, use of Indigenous health workers, and use of appropriate role models. These findings highlight several key priorities that can be used to initiate dialogue on appropriate prevention strategies. Such strategies should be contextualized to the local Indigenous populations.

Book Review: The Ambivalent Welcome: Print Media, Public Opinion and ImmigrationThe Ambivalent Welcome: Print Media, Public Opinion and Immigration. By SimonRita J. and AlexanderSusan H.Westport, CT: Praeger, 1993. Pp. 280

TheAmbivalent Welcome: PrintMedin, Public Opinion and Immigration. By Rita J. Simon and Susan H. Alexander. Westport, CT: Praeger, 1993. Pp. 280 JENNIE R.JOE University ofArizona In this book, the authors select a sampling of major magazines, newspapers, legislationand public polls spanning 110 years to document the vacillating tensions, ambivalence and confusion presented in print media regarding immigration policies of the United States. The selections included are intended to represent a cross-section of beliefs, artitudes and perceptions about immigration policies from 1880 to 1990. The book is based on an earlier edition that has been expanded to include the period between 1980 and 1990, a period marked by two new policies.The expansion alsoincludes an appendix describing anti-immigration movements. The book isdivided into two sections.The first section presents immigration statistics and the history ofU.S. immigration policies. The text begins with a two-page introduction, followed by an easy-to-read statistical overviewfrom 1810 to 1989 highlighting the number of immigrants to the United States and their countries of origin. The data is further broken down by gender and, where data was available, by occupation of the immigrants. The chapter concludes with a brief discussion on illegal aliens, which includes data on apprehensions ofundocumented immigrants from Mexico between 1965 and 1989. ChapterTworeviewssome ofthe major U.S. immigration legislation and political party platforms. The third chapter presents data on some ofthe national polls conducted at different periods (starting with 1930) by various sources to ascertain public opinion about immigration policies. The second section of the book centers on the content ofopinions on immigration policies from selected print media. Chapter Four discusses articles published in the North American Review one of the oldest magazines (1815-1935) covered in the collection. Chapters Five through Ten look at the Saturday EveningPost, the Literary Digest, Harpers, Scribners, AtlanticMonthly, and The Nation, articles about immigration in three major religious publications Christian Century, Commentary, and Commonwealth RetuIers Digest, Time, Newsweek, and U.S. Newsand WorU Report. A selection of The New York Times editorials, columnists, and op-eds between 1880 and 1990 ispresented in Chapter Eleven. Chapter Twelve provides the summary and concluding remarks, followed by two helpful appendices: Appendix A gives a brief profile of the magazines included in the book; Appendix B provides an overview of some of the major anti-immigration organizations in the United States.The final section is a selected bibliography. The collection of print media and immigration legislation included in the volume sharesome biasedviewsand opinions, but the chronicle ofthese attitudes and perceptions is important to understanding the history of U.S. immigration policies. By providing a brief profile of each of the print media included in the database, the authors do alert the reader to the philosophical stance of the publications aswell as that of the writers who contributed articles and opinions about immigration. This approach also indirectly provides an indication of the readership these publications tried to reach. In general, the overview of policies and opinions covered demonstrates that there has been little change over time in the perceptions, artitudes and!or beliefsofmanyAmericans regarding legal and illegal immigrants. For example, the public and political debate about controlling immigration dates back to the 1880s, and some of the arguments for limiting immigration are the same today as they were a hundred yearsago. The book also documents very well both the pressures on Congress to enact immigration laws and how world events have forced exceptions to these laws, e.g., accommodating political and war refugees and the unresolved issue of illegal immigration. The authors also thoroughly document how each new group of immigrants isviewed as undesirable. These immigrants are fre-

The Ambivalent Welcome: Print Media, Public Opinion and Immigration.

Immigration to the United States Wikipedia February 3rd, 2019 Immigration to the United States is the international movement of non U S nationals in order to reside permanently in the country Lawful immigration has been a major source of population growth and cultural change throughout much of the U S history Because the United States is a settler colonial society all Americans with the exception of the small percent of Native Americans can trace